ABSTRACT
BACKGROUND: Paliperidone and mirtazapine are psychotropic agents associated with proarrhythmic effects. CASE PRESENTATION: A 21-year-old woman was admitted to the intensive care unit on two separate occasions for attempting suicide by overdosing on paliperidone and mirtazapine. During both admissions, the patient had atypical chest pain and a first-degree atrioventricular block (AVB) with paradoxical sinus tachycardia, which resolved with the discontinuation of paliperidone and mirtazapine and aggressive intravenous fluids. CONCLUSION: Drug-induced first-degree AVB from paliperidone and mirtazapine should be on the differential diagnosis in patients on paliperidone and/or mirtazapine who present with chest pain, tachycardia or new-onset first-degree AVB. LEARNING POINTS: Paliperidone and mirtazapine are associated with first-degree heart block, which may be a harbinger of torsades de pointes and ventricular fibrillation.Paliperidone and mirtazapine may potentiate each other's proarrhythmic effects since the metabolism of both involve the cytochrome P450 2D6 enzyme.A history of psychiatric illness makes it difficult to rule out atypical chest pain without ECG or troponins and often leads to increased resource utilization, even during times of heavy use like the COVID-19 pandemic.
ABSTRACT
Background Frontline workers, who practice in a variety of settings, have been affected profoundly by the coronavirus disease 2019 (COVID-19) pandemic both professionally and personally. Due to the nature of their job responsibilities, many healthcare workers were exposed to a variety of settings to COVID-19. Because of its high transmissibility, testing of these individuals became prudent to limit the spread, particularly in healthcare settings, to avoid staffing issues as well as iatrogenic infections in patients. This study aimed to report symptoms and testing habits of healthcare workers (HCWs) who were tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness. Methods At the beginning of each shift upon entering the hospital premises, all HCWs were screened for fever using thermal scanners. Also, they were interviewed about exposure history and other symptoms with a questionnaire. Those who experienced symptoms and presented to the employee health clinic for SARS-Cov-2 testing were asked to complete a questionnaire before testing regarding their symptomatology. Of nearly 1000 HCWs tested, 93 of them were positive for the COVID-19. Questionnaire data were then analyzed to identify the most and least common symptoms. Subgroup differences were also examined between the time of symptom onset and the date of the initial test. Results The most common reported symptoms were cough (81%), myalgia (75%), and headache (75%). An equal number of patients presented with myalgia and headache (75%). The mean number of days from the onset of symptoms to the day of testing was approximately 2.6 days; it was different for males (1.82 days) and females (2.8 days), although the results were not statistically significant. Only 53% of the participants experienced fever. The least reported symptoms were chest pain (18%) and rhinorrhea (9%). Infected workers were mainly those working in the COVID-19 unit or had a history of COVID-19 exposure while performing clinical duties. Conclusions Cough, myalgia, and headache were the most commonly reported symptoms. The least common reported symptoms were chest pain and rhinorrhea. Only 53% exhibited fever. Hence thermal scanning for fever detection may not be the ideal way to screen HCW for COVID-19 illness. The time from symptom onset to initial test didnot differ between female and male HCWs.